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ACORP. CERTIFICATE OF LIABILITY INSURANCE ozizM /2iY4 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Brenda Otto CISR Cecil W. Powell & Co. P.O. Drawer 41490 PHONE 904.353.3181 904.353.5722 AIC, No Ext : AIC, Nol: nooaess: sotto @cwpowe77ins.com 219 Newnan St. Jacksonville, FL 32203 -1490 INSURER(S) AFFORDING COVERAGE NAICft INSURER A: Lloyds Underwriters at London INSURED ELM, Inc. INSURER B: UAMAU" U PREMISES (El occurrence) 1035 Kings Avenue INSURER C: COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F7 OCCUR Jacksonville, FL 32207 INSURER D: INSURER E MED EXP (Any one person) ' d INSURER F: $ COVERAGES CERTIFICATE NUMBER: 2014 Prof Liab REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSR ME POLICYNUMBER MMIODIYYYY MMIDD ) LIMITS James C. Coleman III CIC/BSO GENERAL LIABILITY EACH OCCURRENCE $ UAMAU" U PREMISES (El occurrence) $ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F7 OCCUR MED EXP (Any one person) $ PERSONAL B ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OPAGG $ POLICY PRO LOC ECT $ AUTOMOBILE LIABILITY (Ea accident $ BODILY INJURY (Per person) $ ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per acc ) ldenl $ NON -OWNED HIRED AUTOS AUTOS (Per.,radent) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVr❑ OFFICER/MEMBER EXCLUDED? NIA - TORY LIMITS ER E.L. EACH ACCIDENT $ E. L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, describe under DE SCRIPTION OF OPERATIONS below E. L. DISEASE - POLICY LIMIT $ Professions Liability ANE10204561 02/26/2014 02/26/2015 $1,000,000 Limit A Claims Made Policy $15,000 Deductible Per Claim DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule! If more space Is requlretl) PPRO ED AS ,T4 ��y 0 L ) l A rl ClL Laura A. Rossini Assistant City Attorney CERTIFICATE HOLDER CANCELLATION ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Santa Ana AUTHORIZED REPRESENTATIVE 20 Civic Center Plaza, M36 Salta Ana, CA 92701 James C. Coleman III CIC/BSO ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD